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Thread: prolong services

  1. #1

    Default prolong services

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    I need to know if the is a mod or code for proling services for out-pt surgery. I know the ones for e/m services but is there on for out pt surgery?

    thanks toni

  2. #2
    Join Date
    Apr 2007
    Louisville, KY


    Outpatient surgery you say . . . does that mean facility or pro fee?

    From a Pro-fee perspective, you may use Mod-22 (Unusual Procedural Service) on surgery codes. There must be clear reason for this documented in the record. For any Pro-fee anesthesia, there are options to capture that from a number of perspectives: the time element of the service ("from" and "to" times in the equation of the units/per code), also there are the add-on Qualifying Circumstances, which would require medical necessity by way of the appropriate ICD for these more work-intense cases.

    From the facility fee end, there is no specific modifier for the case. You would capture the work involved with the facility CPT surgical codes (APC), any additional services provided (HCPCs/Rev Codes). If, however, the patient was admited to Observation status (post-op), time would be captured there--in terms of how long the patient was in that status, reflected by the appropriate facility fee CPT (APC).

    I'm not sure if this helps, but I really can't think of any other way of capturing time from facility perspective. As I've normally seen it done, the patient would be admitted to observation status with the ICD reflective of the circumstance that occassioned the "prolonged service."

    Good luck.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

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